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Daniel Moon

From: Chris Kim
Sent: Wednesday, July 08, 2015 6:19 PM
To: ACI.ALL
Cc: info@egins.com; Danilo Diaz (ddiaz@wordandbrown.com)
Subject: MEMORANDUM # 104 - A ( 2015 <Health Insurance Renewal> United Healthcare )
Attachments: (HEALTH) Application Form.pdf; (HEALTH) Decline Form.pdf; (HEALTH) Plan Info &
Rate.pdf; (HEALTH) UHC 4 15 Rates (ACI) - Final .pdf; (SAMPLE ONLY)(HEALTH)
Application.pdf; (SAMPLE ONLY)(HEALTH) Decline .pdf

To: ACI ALL
<Health Insurance Renewal>
G
Please note that ACI decided to renew our health insurance plan through a new insurance carrier, United Healthcare, as
of 8/1/2015.
The application for enrollment (Includes Declination – (HEALTH) Decline Form) needs to be submitted to me either
through E mail or by hand no later than Wednesday 7/15/2015.

When we renew the policy, you may add your dependents in the policy at your own cost.
Please make a note that insurance company Does Not Allow to add yourself and any dependent(s) after this
enrollment date or after 8/1/2015.

If you have further questions on the plan election and premium info, please contact EG Insurance Agency, Inc. and
contact Jay Lee by info@egins.com (E mail is preferred method of communication) or call @ 714 533 7089. Also, if you
need detailed explanations of coverage(s), please call Danilo Diaz, Word & Brown General Agency @ (800) 869 6989 for
more information.

The insurance agencies will be at our ACI office on 7/15/2015 (9 AM to 4 PM) to assist filling out the applications. . If
you are on the jobsite or not available on 7/15/2015, you may still get support by email and/or contacting the above
listed numbers.

[ Health Insurance ]

Also, Click and Download the files “ FORMS & INFORMATION (HEALTH) ”

Please refer “(SAMPLE ONLY)” for instruction..

1. Plan Election & Rate: (Plan United Healthcare HMO 20 40/250, HMO 30 50/1000)
Choose either HMO 20 or HMO 30: refer “(HEALTH) Plan Info & Rate”
Individual rate chart: refer “(HEALTH) UHC 4 15 Rates (ACI) Final “

2. Application: (United Healthcare Application)
Application form: fill out the “(HEALTH) Application Form “
A late submission of application will delay all ACI enrollment processes along with new I.D. cards

3. United Healthcare Provider search link: (United Healthcare Provider Search)
If you apply for HMO plan, you must look for you Primary Care Physician through

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